Cancer Support Source-Caregiver

Abstract

The CancerSupportSource-Caregiver (CSS-Caregiver), developed by Zaleta et al. (2023), is a distress screening, referral, and support measure specifically designed to identify the unmet needs of cancer caregivers and connect them with appropriate resources and support. This instrument represents a refinement and finalization of initial work by Shaffer et al. (2019). The CSS-Caregiver, an 18-item screener, was evaluated in a sample of caregivers to individuals with cancer, with reported results on factor analysis, reliability, and validity. The primary purpose of this measure is to offer a multidimensional assessment of caregiver distress and to screen for the risk of clinically significant depression and anxiety. Its utility lies in its potential implementation within distress screening, referral, and follow-up programs, facilitating rapid assessment of caregivers’ unmet needs and enhancing caregiver well-being throughout the care continuum.

Keywords

Anxiety, Cancer Caregivers, Caregiving Tasks, Depression, Distress, Emotional Well-Being, Finances, Healthy Lifestyle, Known-Groups Validity, Needs, Patient Well-Being, Screening Measure.

Authors

Zaleta, Alexandra K.; Miller, Melissa F.; Fortune, Erica E.; Olson, Julie S.; Rogers, Kimberly Papay; Hendershot, Kelly; Ash-Lee, Susan

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Purpose

The purpose of this measure is to provide a multidimensional assessment of caregiver distress that also screens for risk for clinically significant depression and anxiety. It can be implemented within a distress screening, referral, and follow‐up program to rapidly assess caregivers’ unmet needs and enhance caregiver well‐being across the care continuum.

Validity

Convergent Validity: Pearson correlations between CSS-Caregiver factors and validation measures (e.g., depression, anxiety, fatigue, and health impact) demonstrated strong convergent validity, with absolute correlation coefficients (r) equal to or greater than 0.50.

Discriminant Validity: The CSS-Caregiver total score and its factors showed weak correlations with caregiver self-esteem (rs ranging from -0.22 to -0.12), providing support for its discriminant validity.

Known-Groups Validity: Several comparisons, based on the total distress score, supported known-groups validity (e.g., age, gender, income, caregiving hours). The observed directional differences were consistent with hypothesized directions.

Sensitivity and Specificity: For depression scores, a cutoff score of ≥3 (out of a maximum of 8) yielded high sensitivity (94.5%–95.0%) and adequate specificity (63.0%–66.4%). For anxiety, a cutoff score of ≥4 resulted in high sensitivity (86.7%–90.6%) and adequate specificity (66.0%–68.0%).

Reliability

Internal Consistency: The CSS-Caregiver exhibited high internal consistency, with a Cronbach’s alpha coefficient of 0.92.

Test-Retest Reliability: The test-retest reliability for the 18-item measure was 0.85. When including the optional tobacco and substance use item, the test-retest reliability was 0.86. Individual factor Intraclass Correlation Coefficients (ICCs) were all equal to or greater than 0.72.

Factor Analysis

Exploratory Factor Analysis (EFA): After the removal of problematic items, eighteen items were retained, ensuring that at least two items loaded onto each factor. An additional item pertaining to tobacco and substance use did not load onto any of the five identified factors but was retained due to its clinical significance for risk assessment. The final EFA accounted for 67% of the model variance.

Confirmatory Factor Analysis (CFA): CFA confirmed the five-factor structure of the CSS-Caregiver, demonstrating acceptable to good model fit. The fit indices were as follows: RMSEA = 0.07 [90% CI = 0.06–0.09], SRMR = 0.06, CFI = 0.94, TLI = 0.93, χ2 = 216.12.

Instrument

Test Type: Original Screener

Format: Participants rate their level of concern for each item using a 5-point Likert scale (0 = Not at all, 1 = Slightly, 2 = Moderately, 3 = Seriously, and 4 = Very seriously). A total distress score is calculated by summing the item ratings. If a participant has missing responses, the mean of their available items is used to calculate the total score. The depression risk score is derived by summing two specific items, and the anxiety risk score is calculated separately by summing another two specific items.

Language Available: English

Population Group: Human (Male and Female)

Age Group: Adulthood (18 years and older)

Population Details: The study participants were caregivers to people with cancer, located in the United States.

Test Methodology: The methodology involved various psychometric evaluations including Test Validity (Convergent Validity, Discriminant Validity, Known-Groups Validity), Test Reliability (Internal Consistency, Test-Retest Reliability), Factor Analysis (Confirmatory Factor Analysis, Exploratory Factor Analysis), Test Sensitivity, and Test Specificity.

Keywords

Caregiver Burden, Caregivers, Distress, Needs Assessment, Neoplasms, Screening Tests, Stress and Coping Measures, Caregiving.

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Authors

Author ORCID Identifiers:

• Zaleta, Alexandra K.: http://orcid.org/0000-0002-8589-4722

• Miller, Melissa F.: http://orcid.org/0000-0001-8288-2681

• Fortune, Erica E.: http://orcid.org/0000-0002-6748-8229

• Olson, Julie S.: http://orcid.org/0000-0002-4669-3880

• Rogers, Kimberly Papay: http://orcid.org/0000-0003-4740-1269

• Hendershot, Kelly: http://orcid.org/0000-0001-5730-4935

• Ash-Lee, Susan: http://orcid.org/0000-0003-4202-4249

Affiliation and Email Addresses:

• Zaleta, Alexandra K.: Cancer Support Community Research and Training Institute, [email protected]

• Miller, Melissa F.: Cancer Support Community Research and Training Institute

• Fortune, Erica E.: Cancer Support Community Research and Training Institute

• Olson, Julie S.: Cancer Support Community Research and Training Institute

• Rogers, Kimberly Papay: Cancer Support Community Research and Training Institute

• Hendershot, Kelly: Cancer Support Community

• Ash-Lee, Susan: Cancer Support Community

Correspondence Address:

Zaleta, Alexandra K.: Cancer Support Community, 520 Walnut Street, Suite 1170, Philadelphia, Pennsylvania, United States, 19106, [email protected]

Permissions & Fee and Test Year

Permissions: Contact Corresponding Author

Commercial Use: No

Fee: No

Test Year: 2023

References

Zaleta, A. K., Miller, M. F., Fortune, E. E., Olson, J. S., Rogers, K. P., Hendershot, K., & Ash‐Lee, S. (2023). CancerSupportSourceTM‐Caregiver: Development of a distress screening measure for cancer caregivers. Psycho-Oncology, 32(3), 418–428. https://doi.org/10.1002/pon.6092

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Items of the CancerSupportSource™‐Caregiver (CSS‐Caregiver)

The CancerSupportSource™‐Caregiver (CSS‐Caregiver) consists of 18 items, along with one additional screening item that assesses tobacco and substance use. The measure is structured around five main factors:

• Emotional well‐being

• Patient well‐being

• Caregiving tasks

• Finances

• Healthy lifestyle

Additionally, the instrument includes subscales for:

• Depression risk

• Anxiety risk

No specific items are provided in the provided text, however, they are available in the source reference: Zaleta et al. (2023), Table 2, Page 423.